Collaboration and strategic planning across a multidisciplinary team are key to eliminating potential barriers to fertility discussions with adolescents and young adult (AYA) patients. These findings were presented at the 47th Annual Oncology Nursing Society (ONS) Congress.

AYA patients are persons aged 15 to 39 years. Approximately 70,000 cancer cases occur in this population annually. Most AYA patients have not begun or completed building families, and many survivors desire parenthood. Therefore, loss of fertility is a critical concern. Most AYA patients (30% to 60%) in the United States and United Kingdom do not recall having a conversation about fertility with their oncology team.

Fertility-related discussions are crucial, yet multiple barriers exist. Known barriers include lack of time to explore concerns, potential delay in treatment, perception of cost burden, no fertility specialist network, and a lack of experience navigating barriers.

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Nurses specifically cite a lack of familiarity with fertility risk and preservation options, as well as a lack of institutional guidelines. Therefore, a team of oncology clinicians at a southwestern cancer center sought to identify the barriers to fertility discussions with AYA patients and implement strategic changes to eliminate them.

“A worst case scenario is not that [AYAs] are unable to bank but that [they] are unaware of [their] fertility risk,” stated Donna Herrera Bell, an AYA nurse practitioner at the University of Texas MD Anderson Cancer Center in Houston, during her presentation.

The primary intervention was initiating a discussion regarding fertility risks and preservation options with all patients in the AYA clinic. “We wanted to reach out early on to offer comprehensive information on risk and options,” explained Bell.

Collaborations with a reproductive endocrinologist and infertility (REI) specialist and the AYA patient navigator were established. This allowed for earlier referral of female AYA patients interested in fertility preservation.

A consult service was created to address the fertility needs of male AYA inpatients, and a cryobank willing to coordinate inpatient banking was identified. Philanthropic funds were secured to support financial needs of these patients and reduced pricing was negotiated.

An oncofertility best practice advisory (BPA) was developed for use in the institution’s electronic medical record. The BPA alerts the oncology team to discuss fertility with the patient and place a consult to the AYA service when placing a new chemotherapy treatment plan.

The program launched in June 2018, with 88 patients seen that year. In the past year, 1030 consults were provided.

Further vision for the program is to pursue strategic partnerships that will expand female fertility preservation options, build community partnerships, and continue advocacy efforts to meet the needs of AYAs.

Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.


Herrera Bell D, McKenzie L, Yarbrough A, et al. Eliminating barriers to fertility discussions in AYA oncology. Oral presentation at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.